Schotten Clemens, Ostertag Bastian, Sowa Jan-Peter, Manka Paul, Bechmann Lars P, Hilgard Gudrun, Marquardt Claudio, Wichert Marc, Toyoda Hidenori, Lange Christian M, Canbay Ali, Johnson Philip, Wedemeyer Heiner, Best Jan
Department of Gastroenterology and Hepatology, University Hospital Essen, 45147 Essen, Germany.
Department of Internal Medicine, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, 44892 Bochum, Germany.
Pharmaceuticals (Basel). 2021 Jul 27;14(8):735. doi: 10.3390/ph14080735.
Despite vaccination programs and direct antiviral treatments, the incidence of virus-related hepatocellular carcinoma (HCC) remains high, while ultrasound-based detection rates for early-stage HCC is continuously low. To address this insufficiency, we set out to characterize whether the GALAD score, which incorporates gender, age, and serum levels of AFP, AFP isoform L3 (AFP-L3), and des-gamma-carboxy-prothrombin (DCP), can improve early-stage HCC detection in a Caucasian HBV/HCV cohort. In a retrospective German single-center study, 182 patients with HBV, 223 with HCV and 168 with other etiology (OE) of chronic liver disease (CLD) were enrolled. HCC was confirmed in 52 HBV, 84 HCV and 60 OE CLD patients. The diagnostic performance of the single biomarkers in HCC detection was compared to the GALAD model. At initial diagnosis, most patients were at (very) early BCLC 0 ( = 14/7%) or A ( = 56/29%) or intermediate stage BCLC B ( = 93/47%) HCC in all three subgroups. In the BCLC 0/A cohort, GALAD exhibited an AUC of 0.94 discriminating HCC from non-HCC, surpassing AFP (AUC 0.86), AFP-L3 (AUC 0.83) and DCP (AUC 0.83). In the HBV population, GALAD achieved an AUC of 0.96, in HCV an AUC of 0.98 and in OE an AUC of 0.99, clearly superior to the biomarkers alone. Furthermore, in HCV patients GALAD showed a significantly higher specificity (89%) versus AFP (64%) alone. In chronic viral hepatitis, the GALAD model showed superior performance in detection of early-stage HCC, while exhibiting higher specificity in HCV patients compared to AFP alone. We conclude that the GALAD score shows potential for HCC surveillance in Caucasian HBV/HCV patients.
尽管有疫苗接种计划和直接抗病毒治疗，但病毒相关肝细胞癌（HCC）的发病率仍然很高，而基于超声的早期HCC检测率持续较低。为了解决这一不足，我们着手研究结合性别、年龄以及甲胎蛋白（AFP）、甲胎蛋白异构体L3（AFP-L3）和异常凝血酶原（DCP）血清水平的GALAD评分是否能提高高加索地区乙肝/丙肝队列中早期HCC的检测率。在一项德国单中心回顾性研究中，纳入了182例乙肝患者、223例丙肝患者和168例其他病因（OE）的慢性肝病（CLD）患者。52例乙肝、84例丙肝和60例OE CLD患者被确诊为HCC。将单个生物标志物在HCC检测中的诊断性能与GALAD模型进行比较。在初次诊断时，所有三个亚组中的大多数患者处于（非常）早期BCLC 0期（=14/7%）或A期（=56/29%）或中期BCLC B期（=93/47%）HCC。在BCLC 0/A队列中，GALAD区分HCC与非HCC的曲线下面积（AUC）为0.94，超过了AFP（AUC 0.86）、AFP-L3（AUC 0.83）和DCP（AUC 0.83）。在乙肝人群中，GALAD的AUC为0.96，丙肝人群中为0.98，OE人群中为0.99，明显优于单独的生物标志物。此外，在丙肝患者中，GALAD显示出比单独的AFP更高的特异性（89%）。在慢性病毒性肝炎中，GALAD模型在早期HCC检测中表现出卓越性能，与单独的AFP相比，在丙肝患者中表现出更高的特异性。我们得出结论，GALAD评分在高加索地区乙肝/丙肝患者的HCC监测中显示出潜力。
